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- W2024146031 abstract "In this issue, Cancio et al1 report that, in a review of acute burn resuscitation, two measures obtained from blood gases—alveolar-arterial oxygen difference (AaDO2) and base deficit (BD)—did not improve mortality prediction when added to the universally accepted variables age, burn size, and inhalation injury. In that sense, the title of their reoirt is misleading; they could have claimed the opposite result with equal validity. This report complements a number of other of recent studies evaluating metabolic abnormalities as predictors of outcome. In trauma patients, increased levels of lactic acid (LA) predict ongoing hemorrhage and the need to escalate resuscitation2; in burns, increases in the levels of BD and LA have been variously found to correlate with increasing burn size, inhalation injury, systemic inflammation, fluid requirements, and rate of mortality.3,–6 Nonetheless, the clinical utility of these measurements remains unclear. Systemic acidosis is a valid marker for the unmet metabolic demands that define the shock state. However, as demonstrated, these values may not improve mortality prediction in burn patients, who already have uniquely quantifiable injuries. The authors deserve praise for their careful statistical analysis, which illuminated this point, and for thoughtfully discussing other limitations of their review. However, their study also is compromised by other considerations. First, they failed to measure LA, whichmay be a more accurate indicator of ongoing shock.7,8 Second, they used mean values of AaDO2 and BD collected during the first 2 days of treatment, so that patients with different amounts of data were compared and the most abnormal values were “diluted” as treatment proceeded. Finally, of the 55 deaths reviewed, 9 had support withdrawn, and 3 were the result of “hypoxia at the scene.” Correlation of death with physiologic parameters in these patients might be predictably poor. It was surprising that AaDO2 correlated more with early death because inhalation injury typically causes late deaths from pneumonia and multiple organ failure. BD, reflecting acute hypoperfusion, might have been predicted to be a better marker for early mortality." @default.
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- W2024146031 doi "https://doi.org/10.1097/01.bcr.0000217579.60551.89" @default.
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